替考拉宁治疗脓毒症患者的血药谷浓度与临床疗效和安全性的相关性分析  

Correlation analysis of blood trough concentrations with clinical efficacy and safety in patients with sepsis treated with teicoplanin

作　　者：岑菁 高倩 刘睿翔 马攀 Cen Jing;Gao Qian;Liu Ruixiang;Ma Pan(Department of Pharmacy,the First Affiliated Hospital of Army Medical University,Chongqing 400038)

机构地区：[1]陆军军医大学第一附属医院药学部,重庆400038

出　　处：《中国抗生素杂志》2025年第1期92-98,共7页Chinese Journal of Antibiotics

基　　金：重庆市科卫联合医学科研项目(No.2023QNXM031)。

摘　　要：目的探讨脓毒症患者使用替考拉宁血药谷浓度(C_(min))达标情况与疗效和安全性的相关性,为临床合理用药提供参考。方法回顾性收集2017年11月—2022年7月陆军军医大学第一附属医院脓毒症患者使用替考拉宁治疗后的血药谷浓度达标情况、临床疗效及安全性。结果116例脓毒症患者共监测替考拉宁C_(min)169例次。第4剂前和第6剂前C_(min)平均值分别为(16.35±10.05)mg/L和(20.46±10.27)mg/L,差异有统计学意义(P<0.05)。第4剂前和第6剂前C_(min)≥15 mg/L的达标率分别为43.97%(51/116)和62.26%(33/53),差异无统计学意义(P=0.226)。116例患者临床有效率85.34%,不良反应发生率6.03%。75例目标性治疗患者共检出90株革兰阳性菌,临床总有效率86.67%,细菌清除率87.78%,不良反应发生率6.67%。目标性治疗中按C_(min)达标情况分为达标组和未达标组,两组的临床总有效率分别为93.18%(41/44)和77.42%(24/31),细菌总清除率分别为92.98%(53/57)和78.79%(26/33),差异均有统计学意义(P<0.05);不良反应发生率分别为4.55%(2/44)和9.68%(3/31),差异无统计学意义(P>0.05)。按替考拉宁起始负荷剂量分为高剂量组和低剂量组,两组的临床总有效率分别为97.06%(33/34)和78.05%(32/41),细菌总清除率分别为97.73%(43/44)和78.79%(36/46),差异均有统计学意义(P<0.05);不良反应发生率分别为5.88%(2/34)和7.32%(3/41),差异无统计学意义(P>0.05)。结论替考拉宁在治疗脓毒症革兰阳性菌感染时疗效好,安全性较高。替考拉宁起始负荷剂量及C_(min)与临床疗效呈正相关,且未导致不良反应增加。Objective To explore the correlation between the blood trough concentration of teicoplanin and its efficacy and safety in patients with sepsis in order to provide references for rational drug use.Methods A retrospective analysis was performed in sepsis patients who were treated with teicoplanin and monitored serum concentrations of teicoplanin,efficacy and safety from November 2017 to July 2022 in the First Affiliated Hospital of Army Medical University.Results A total of 169 samples of teicoplanin C_(min) in 116 sepsis patients were included.The average trough concentrations before the fourth dose and the sixth dose were(16.35±10.05)mg/L and(20.46±10.27)mg/L,respectively,which had a statistical difference(P<0.05).The standard-achieving rate of target concentration with C_(min)≥15 mg/L before the fourth dose and the sixth dose were 43.97%(51/116)and 62.26%(33/53),respectively,but had no statistical significance(P>0.05).The clinical effective rate of 116 patients was 85.34%,and the incidence of adverse reactions was 6.03%.A total of 90 strains of Gram-positive bacteria were detected in 75 patients who received targeted therapy,with a total clinical effective rate of 86.67%,clearance rates of Gram-positive bacteria of 87.78%,and an incidence of adverse reactions of 6.67%.In targeted therapy,the patients were divided into the target trough concentration group and the low trough concentration group.The total clinical effective rates of the two groups were 93.18%(41/44)and 77.42%(24/31),respectively,and the total bacterial clearance rates were 92.98%(53/57)and 78.79%(26/33),respectively,both with statistical significance(P<0.05).The incidence of adverse reactions was 4.55%(2/44)and 9.68%(3/31),respectively,but had no statistical significance(P>0.05).According to the initial loading dose of teicoplanin,the patients were divided into the high-load dose group and the low-load group.The total clinical effective rates of two groups were 97.06%(33/34)and 78.05%(32/41),respectively,and the bacterial clearance rates were

关 键 词：替考拉宁 脓毒症 血药谷浓度 负荷剂量 临床疗效 

分 类 号：R978[医药卫生—药品]